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Premature ejaculation is one of the most common sexual disorders in men. At the same time, it is not a full-blown disease, because the function of the genitals is preserved, and at certain moments in life (adolescence, long periods of sexual abstinence) it is the norm at all. Premature ejaculation (PE) refers to ejaculation with little sexual stimulation, as well as the inability to delay ejaculation for the time required for full sexual intercourse. This leads to sexual partners not being satisfied with sex and conflicts arise. The man begins to experience psychological problems, and fear of intimacy. If the pathology turns into a chronic form and begins to occur more and more often, the help of an andrologist is required.
Premature ejaculation is an ejaculation disorder and accounts for 25-60% of all forms of functional sexual disorders in men. Premature ejaculation is not considered an organic disorder, it is a sexual dysfunction that consists of an inability to control ejaculation sufficiently to achieve sexual satisfaction during coitus by both partners. According to the WHO, the problem of premature ejaculation is faced by at least 40% of men of all ages worldwide. Different authors consider the time factor (duration of intercourse less than 1-2 minutes) or the number of frictions (less than 8-15) to be the criteria for premature ejaculation.
The problem of premature ejaculation is mostly a social problem, because from the medical point of view there are no organic changes or obvious reasons for it. There is no unified norm for the duration of sexual intercourse, but the average duration of the friction period varies from 2 to 10 minutes, depending on the characteristics of the body, the situation during coitus and the period of abstinence. However, the subjective opinion of men can cause the false opinion that there is a problem of premature ejaculation and short intercourse, which in turn has an adverse effect on the family relationship, reduces the self-esteem of both partners and often leads to family breakdown.
Premature ejaculation is considered if ejaculation regularly occurs before both partners have received sexual satisfaction, provided that the friction period was less than 2 minutes. With a long period of foreplay, strong sexual arousal, especially after significant abstinence, ejaculation may occur even before genital contact, which is not considered pathological. Many people mistake an inability to have a vaginal orgasm or anorgasmia in women for premature ejaculation, because the friction period, often lasting more than 20 minutes, is not enough to satisfy the partner.
That is, in medical terms, premature ejaculation is a frequently repeated ejaculation after minimal sexual stimulation before or after the insertion of the penis into the vagina. The opinion that uncontrolled ejaculation is premature is incorrect, in addition, it generates serious and intractable psychological problems.
To date, numerous studies in the field of andrology prove that most premature ejaculations are psychogenic in nature and refer to a psychogenic form of premature ejaculation. Lack of sexual experience and theoretical knowledge at the time of the beginning of sexual life, combined with false accounts of sexual experience from peers later form a persistent failure syndrome. This is because a single failed intercourse in the development of phobias leads to the repetition of the scenario. Psychophysical reasons for the development of repeated premature ejaculation lie in the formation of a reflex arc, which after formation contributes to premature ejaculation, subsequently developing secondary phenomena of colliculitis (inflammation of the seminal tubercle).
Inflammatory diseases of the genital appendages especially in the absence of treatment and the accession of psychogenic factors can form a persistent syndrome of premature ejaculation. Thus, in colliculitis of inflammatory or hypertrophic nature in the seminal tubercle increases blood supply, which is especially evident at the time of intercourse. This increases the ascending nerve impulses and in response to irritation of the central nervous system orgasm and premature ejaculation occur. If left untreated, irritation of this area intensifies, resulting in a loss of quality of the orgasm itself, and frequent premature ejaculation is formed. Often the prostate gland is also involved in the inflammatory process, or first there is inflammation of the prostate, which later passes to the seminal mound as well. Therefore, when correcting premature ejaculation, it is important to carry out anti-inflammatory therapy of all the appendages of the sex glands.
With neurological changes that are accompanied by hypersensitivity of the penile head, the number of receptors in the neural arch increases, resulting in premature ejaculation. A short frenulum as a cause of premature ejaculation is practically not considered, because, after frenulum plasty, sexual life returns to normal.
Premature Ejaculation Diagnosis
Your doctor probably will start by asking if you’ve always had the problem or if it’s a new thing. They may ask about your sex life or your relationships. You’ll probably get a physical exam, too.
If your doctor thinks emotional issues are causing your PE, they may refer you to a mental health professional who works with people who have trouble with sex. If a physical problem is causing it, they might recommend that you see a doctor called a urologist, who specializes in conditions that affect your urinary system. There are 2 types of premature ejaculation:
- primary premature ejaculation – where you have always had the problem
- secondary premature ejaculation (or "acquired premature ejaculation") – where you recently developed the problem
The causes of primary premature ejaculation are often psychological, such as having a traumatic sexual experience at an early age. Secondary premature ejaculation can be caused by both psychological and physical factors. Physical causes can include drinking too much alcohol and inflammation of the prostate gland (prostatitis).
If your premature ejaculation is caused by a physical condition, treating the underlying condition should help. A GP can suggest possible treatment options.
Treating premature ejaculation caused by psychological factors can be more challenging. But most men who persevere with treatment find the problem resolves.
There are a number of self-help techniques you can try before getting medical help.
- masturbating 1 to 2 hours before having sex
- using a thick condom to help decrease sensation
- taking a deep breath to briefly shut down the ejaculatory reflex (an automatic reflex of the body, during which you ejaculate)
- Have sex with your partner on top (to allow them to pull away when you're close to ejaculating)
- taking breaks during sex and distracting yourself by thinking about something completely different
If you're in a long-term relationship, you may benefit from having couples therapy.
You'll be encouraged to explore issues that may be affecting your relationship and be given advice on how to resolve them. You may also be shown techniques that can help you "unlearn" the habit of premature ejaculation.